Provider Demographics
NPI:1487608717
Name:KANSAL, KUSUM R (MD)
Entity type:Individual
Prefix:DR
First Name:KUSUM
Middle Name:R
Last Name:KANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-946-5055
Practice Address - Street 1:714 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2626
Practice Address - Country:US
Practice Address - Phone:814-942-5466
Practice Address - Fax:814-201-2280
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist